title: Rolapitant for the prevention of postoperative nausea and vomiting: a prospective, double-blinded, placebo-controlled randomized trial.
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) are common complications after surgery. Neurokinin-1 (NK(1)) receptor antagonists have been shown to be safe and effective for the prevention and treatment of PONV in humans. Rolapitant is a potent, selective NK1 receptor antagonist that is rapidly absorbed, has a remarkably long half-life (up to180 hours), and appears to have a low potential for drug-drug interactions. We evaluated the dose response for rolapitant for the prevention of PONV in subjects at high risk for this condition, and rolapitant's effects on preventing delayed PONV were explored up to 5 days after surgery.
  
  
  METHODS
  A randomized, multicenter, double-blind, dose-ranging study of rolapitant was conducted with placebo and active control groups. Six hundred nineteen adult women undergoing open abdominal surgery were randomly assigned in equal ratios to 1 of 6 study arms: oral rolapitant in 5-mg, 20-mg, 70-mg, or 200-mg doses; IV ondansetron 4 mg; or placebo, stratified by history of PONV or motion sickness. The primary study endpoint was absence of emetic episodes, regardless of use of rescue medication, at 24 hours after extubation.
  
  
  RESULTS
  Groups assigned to rolapitant 20-mg, 70-mg, and 200-mg had a higher incidence of no emesis in comparison with placebo at 24 hours after surgery. A linear relationship between rolapitant dose and primary outcome was seen. The probability of an emetic episode was significantly lower in the rolapitant 70-mg and 200-mg groups in comparison with placebo (P ≤ 0.001 based on the log-rank test). No significant differences were noted between rolapitant and the active control (ondansetron) at 24 hours after surgery, but there was a higher incidence of no emesis (regardless of rescue medication use) in the rolapitant 200- and 70-mg groups at 72 and 120 hours, respectively.
  
  
  CONCLUSIONS
  Rolapitant is superior to placebo in reducing emetic episodes after surgery and reduces the incidence of vomiting in a dose-dependent manner. No differences in side effect profile were observed between rolapitant and placebo.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, CB 3094, Durham, NC 27710, USA. tjgan@duke.edu
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
authors.forename: Jiezhun
authors.initials: J
authors.lastname: Gu
authors.forename: Neil
authors.initials: N
authors.lastname: Singla
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
authors.forename: Michael H
authors.initials: MH
authors.lastname: Pearman
authors.forename: Sergio D
authors.initials: SD
authors.lastname: Bergese
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Habib
authors.forename: Keith A
authors.initials: KA
authors.lastname: Candiotti
authors.forename: Yi
authors.initials: Y
authors.lastname: Mo
authors.forename: Susan
authors.initials: S
authors.lastname: Huyck
authors.forename: Mary R
authors.initials: MR
authors.lastname: Creed
authors.forename: Marc
authors.initials: M
authors.lastname: Cantillon
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008875:Middle Aged; D064729:Neurokinin-1 Receptor Antagonists; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control*; D018040:Receptors, Neurokinin-1 / Q000502:physiology
chemical_list: D000932:Antiemetics; D064729:Neurokinin-1 Receptor Antagonists; D018040:Receptors, Neurokinin-1